1. Measuring Health and Homelessness - in Fife Dr Neil Hamlet Consultant Public Health Medicine Fife Health & Homelessness Lead neil.hamlet@nhs.net

2. Substance Misuse Dental Care Foot and skin care Alcohol Abuse Mental Health Issues Nutrition and diet Homelessness Homelessness - a cross-cutting agenda Community Health Partnerships Social Work NHS Acute Services Registered Social Landlords Council Housing Departments Third Sector Agencies Health & Social Care Integration Bodies Alcohol and Drug Partnerships (ADPs)

3. Employment Family nurturing (conflict resolution) Education & skills Income maximisation Honour, Respect Purpose, Hope Coping & resilience Homelessness - a agenda Homelessness - a prevention agenda Social Work NHS Outreach Services Registered Social Landlords Council Housing Departments Third Sector Agencies Health & Social Care Integration Bodies Alcohol and Drug Partnerships (ADPs)

4. Housing Vol Sector NHS HSCP Data – sharing across agencies

5. Linkage of Hospital data and Homelessness data in Fife Bryan Archibald, Senior Information Officer barchibald@nhs.netbarchibald@nhs.net Bryan Archibald barchibald@nhs.net

6. The Data Sources Fife Council HL1 National data set for each homeless application Based on the application (not the number of homeless individuals) NHS Fife Acute Hospitals OASIS (patient administration system) SMR data submitted to ISD (information Services Division of NHS Scotland) Based on Patient Episodes http://www.scotland.gov.uk/Topics/Statistics/15257/22833

7. Applications by household type 05/0606/0707/0808/0909/1010/1111/1212/13 Single Person 25442641218520892301251722611631 Single Parent 10591110879849111613511094760 Couple 269295261211266286259188 Couple with Children 265293253246273307266199 Other 2125222120423226 Other with Children 14 312126312120 All 41724378363134374002453439332824 HL1 applications by ‘household type’ Half of these people are included Unknown proportion are included All children <15 and many women will not appear in the results

8. NHS Data (OASIS) A&E (and Minor Injuries Unit [MIU]) Inpatients & Day cases Obstetrics Mental Health Inpatients Outpatients Mental Health Outpatients

13. So far so good but what does this mean? We need a comparator for the homeless populationWe need a comparator for the homeless population Fife’s ‘securely - housed’ populationFife’s ‘securely - housed’ population Try to compare by similar age profileTry to compare by similar age profile Started with Fife population 15-64 as our crude method of ‘standardisation’Started with Fife population 15-64 as our crude method of ‘standardisation’ Further refinements planned in ‘standardisation process’Further refinements planned in ‘standardisation process’ Aiming to compare ‘apples’ with ‘apples’ by security of housing as defined by HL1 registrationAiming to compare ‘apples’ with ‘apples’ by security of housing as defined by HL1 registration

14. Compare this to the Fife which is stable around 365,000.

17. The value of shared data analysis ‘Insecurely Housed’‘Securely Housed’

18. Abuse ? Pragmatic ? £££

19. Over 50% are under 30 yrs Over 80% are under 40 yrs

20. Over 50% are under 30 yrs Over 80% are under 40 yrs

21. The Frequent Fliers

22. £

23. Revolving Hospital Door effect

26. Clear role for Community Safety Partnerships ?

30. Changed address Fearful to open official mail Appointment too early No money for the bus ‘it won’t do any good’ Access / Expectation

31. Adding in the £ signs NHS Costs Book (2013/2014 ) Emergency Ambulance call£261 A/E attendance£115 In patient case (Gastroenterology wards)£2916 Addiction cost (community attendance)£144 General Psychiatry inpatient cost / week£2452

32. Inverse Care Law The availability of good medical care tends to vary inversely with the need for it in the population served.” “ The availability of good medical care tends to vary inversely with the need for it in the population served.” “Those who need healthcare least use the services more, and more effectively, than those with the greatest need and those people in the worst health receive the least services.” Julian Tudor Hart 1971

33. Making a Difference On call nurse manager gets a text alert on her work phone when a homeless person is seen in Accident and Emergency Dept. A daily report is now generated listing all the patients in the hospital at 8am who have a temporary homeless accommodation address.

34. Admissions to Fife Hospitals with Homeless Accommodation Address Based on Current Homeless Accommodation List & Patient Address in Oasis at time of report refresh Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Jul-15Aug-15Sep-15 Elective Medical23 21 Orthopaedic0 01 Surgical01 1 Theatres0 11 Women & Children0 Total240 43000000 Emergency Medical8 554 3 Orthopaedic4 5334 Surgical2 11 Theatres1 141 Women & Children5 1014 Total202122 129000000

35. Fife Housing Register CategoryNumbersPercentage Lack of Security (LS)257223.92% Management Points (MG)50.05% No Immediate Need zero points (NIIN)157314.45% No Priority Need, Outwith Fife, No link (NPA)3172.90% Poor Housing (PH)268324.66% Social/Medical (SM)268424.36% Urgent Housing (UH)1711.62% Urgent Housing Homeless (UHH)7186.87% Urgent Homeless Medical UHM)750.71% Urgent Housing Medical (UM)490.46% Grand Total10847100.00% A new approach to early detection of vulnerability and preventive action

36. What Next ? Data: - refine, analyse and shareData: - refine, analyse and share –Add in cost implications –Repeat for Prevent 1 dataset New ways of working:New ways of working: –Embed Housing Options expertise in Secondary Care –Cross-referral for early wholistic prevention and early intervention New partnerships:New partnerships: Education, Community Safety, ADPs, Employability Partnerships, Welfare Reform actions, Foodbanks, Faith Groups (and overarching HSCPs) New mindset:New mindset: –Assets based –Psychological trauma-based practice

37. Resilience Factors Supportive friends / familySupportive friends / family Strong social networksStrong social networks Appropriate support services Savings or access to financial help Available advice & advocacy In stable employment Personal empowerment/capacity

38. 'Houseless and Hungry' by Luke Fildes depicting homeless paupers queuing outside the casual ward of a London workhouse Meet needs of safety, nurture, belonging and purpose “We believe that health and homelessness services can work better together to ensure that an individual's health needs are identified and addressed as quickly as possible. NHS acute services currently bear the brunt of the health and other complex problems experienced by those who are homeless. A&E visits per homeless person are four times higher than that of the general public and over a quarter of those surveyed had been admitted to hospital in the previous six months” Rick Henderson, chief executive of Homeless LinkHomeless Link